| NPI | 1982655502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NC 4595) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NC 4595) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2019-11-19 |